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A new study published in the Journal of General Internal Medicine looked at adverse childhood experiences (ACEs) and aging-associated functional impairment in a national sample of older community-dwelling adults.

“In recent years, there has been growing interest and research in how stress and traumatic events that happen in childhood can impact people’s health in their early adult years, from increasing people’s risk of depression all the way to other diseases like diabetes,” study author Victoria M. Lee told us. “What we do not know though, is whether these adverse childhood experiences could be associated with worse health and functioning many decades later, such as in older age. This is what our study set out to find.”

Going into the study, the researchers’ leading suspicion was that ACEs may have lasting associations with worse health outcomes in older age, especially given their known detrimental effects on health for young and middle-aged adults. But they also would not have been surprised if they did not find any associations, given there are numerous factors that affect health in later years: socioeconomic factors, systemic barriers, genetic predispositions, and health-related behaviors, to name a few–and given that so much time has lapsed since the exposure of the childhood adversity.

“I have always had a strong interest in holistic and integrative medicine–how a person’s health is influenced by a combination of emotional, mental, spiritual, and physical factors,” Lee told us. “To me, studying the effects of adverse childhood experiences and its impact on health across the lifespan is right up this alley. Furthermore, there has been recent legislation in California and other states calling for more coverage of screening for these adverse childhood events. We thought it would be very timely to study this topic in light of these policy changes.”

The research team analyzed data from over 3,300 U.S. adults ages 50-97, as part of the National Social Life, Health, and Aging Project, who provided data as to whether or not they experienced six types of adverse childhood events: experiencing or witnessing physical violence or abuse, childhood financial hardship, separation from a parent, poor childhood health, and unhappy family life. They then looked at whether those who had experienced ACEs and those who did not report any ACEs demonstrated any differences in their physical mobility and cognitive function as well as their ability to perform key activities of daily life (e.g., bathing, dressing, feeding oneself).

To measure physical mobility, participants were asked to complete standardized tests that involved measuring their balance, walking speed, and ability to rise from a chair. For cognitive impairment, participants were asked to complete standardized tests that measured their memory, language, ability to make mental calculations, and other tests that are validated by the medical community.

“Firstly, we found that over 40% of older adults in our study recalled one or more types of adverse childhood experiences,” Lee told us. “The older adults who did report adverse childhood experiences were 30% more likely to have mobility impairment and 26% more likely to have cognitive impairment compared to those who did not report having any adverse childhood experiences. Having a history of adverse childhood experiences also increased a participant’s chance of having difficulty performing key activities of daily living by 40%.”

Furthermore, the study showed that certain types of adverse childhood events may have especially strong implications for health outcomes. For instance, experiencing violence as a child may be especially harmful and nearly doubled a participant’s chances of having difficulty performing key activities of daily living in older age.

“We were surprised in a few different ways,” Lee told us. “To start, it's both surprising and significant that stress and trauma that happens during childhood can still have ramifications for health anywhere from five to nine decades later. We don’t exactly know why this is.”

One theory, Lee explained, is that violence and abuse in childhood lead to a prolonged stress response which can actually have direct effects on our genes. These experiences could also result in more socioeconomic instability or more susceptibility to higher-risk health behaviors in adulthood–all of which can lead to worse physical and cognitive health as well as functional ability in later years.

“While it can be easier to wrap our minds around how experiencing traumatic events or severe illness as a child can have lasting negative health consequences in older age, another surprise in our study was finding that even exposures such as having an unhappy childhood or facing financial stress as a child was linked with greater risk of having cognitive impairment and difficulty performing key activities of daily living in older age, respectively.”

Lee believes the study results could suggest potential changes in the way older adults are taken of. Up until now, clinicians and geriatricians caring for older patients usually focus on medical complaints that are currently bothering patients and would not think to probe for details from a patient’s childhood, which is entirely understandable given the lack of reason to do so as well as the time-pressures that providers face.

“But our research posits that it might actually be worthwhile to screen for or explore the role of early life events that may be affecting the health of our older patients,” Lee told us. “Identifying adults who have a history of ACEs earlier on may help offer prevention strategies, such as physical therapy for strength building and falls-prevention, that would help these patients age better and have better health outcomes when they are older.”

While legislation has been passed in California and other states to screen for ACEs, Lee believes the study suggests that further work and resources are needed to prevent these ACEs from happening in the first place.

“How can we as a society recognize that childhood violence, abuse, family instability are actually factors that can influence health, and how can we act upon them?” Lee told us. “Our hope is that this study ignites further interest and research into this important and understudied topic.”

One big area of controversy and development in the field of ACEs is what we do for patients once we know that they have a history of an adverse childhood event. Many experts state that we should not screen for ACEs unless there are interventions or support services we can offer them, otherwise, screening may cause the patient unnecessary retraumatization and be a poor use of already limited healthcare resources and time.

“One question our study raises is, even if we may not have immediate resources to offer older adults–since their adverse childhood exposure occurred so many years ago–could there still be some therapeutic benefit in healthcare providers at least asking older patients about these events?” Lee told us. “Given that the adoption of ACEs screening is still relatively new, chances are, most older patients likely have never been asked before about childhood adversity in a healthcare setting or even considered that events that happened to them over 50 years ago may be affecting their current health. This is still a burgeoning field and we’re excited to see further research and findings.”